Policies Shaping Nursing Home Medication Practices: Involving Nurses to Advance Individualized Deprescribing

Area of Science:

• Gerontology
• Pharmacology
• Health Policy

Background:

• Deprescribing is a common practice for older adults, particularly in nursing homes.
• It involves individualized medication review to mitigate polypharmacy and inappropriate medication use.
• Prescribing in nursing homes is influenced by federal, state, and local policies.

Purpose of the Study:

• To examine the influence of policies on prescribing practices in nursing homes.
• To understand how these policies impact the transition to individualized deprescribing.
• To inform gerontological nursing practices regarding medication optimization.

Main Methods:

• Policy analysis of historical and contemporaneous regulations.
• Review of prescribing trends in nursing home settings.
• Qualitative assessment of the impact on clinical practice.

Main Results:

• Policies have historically targeted chemical restraints and unnecessary medications.
• These policies can shape prescribing and deprescribing practices, sometimes with unintended consequences.
• A gap exists between policy intentions and individualized patient care.

Conclusions:

• Gerontological nurses must understand policy nuances to effectively implement individualized deprescribing.
• Policy evaluation is essential to ensure it supports, rather than hinders, optimal medication management.
• Transitioning to person-centered care requires a critical examination of the regulatory landscape.